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Bell's Palsy

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Bell’s Palsy

* Sir Charles Bell first described the anatomy and function of the facial nerve in the 1800s. * Bells Palsy describes the sudden paralysis of the facial (VIIth) cranial nerve which renders the patient unable to control the facial muscles on the affected side. * Also called the facial paralysis, is a disorder of the 7th cranial (facial) nerve, characterized by unilateral paralysis of the muscles * The aetiology is unclear although for some cases the presumed pathophysiology of Bells Palsy is due to inflammation from a viral infection. * It may recur on the same or opposite side of the face, and can be transient and permanent. * This disorder can occur at any ages but most often in adults between 20 and 60. * The incidence is equal in men and women. * 80% of clients recover completely within a few weeks to a few months (3/4 recover without treatment). * 15% recover some function but have permanent facial paralysis.

POSSIBLE CAUSES

* Blockage of the seventh cranial nerve (Facial) * Infection from herpes simplex virus * Meningitis * Compression of the nerve by a tumor * Haemorrhage * Trauma to the facial nerve

RISK FACTORS

* Pregnancy increases the risk threefold – mainly seen in third trimester to first week post partum * Diabetes * Viruses: Herpes Simplex Virus and Herpes Zoster Virus

Sensory
Loss of taste

SYMPTOMS

* Sudden onset (over hours) unilateral lower motor neurone facial paralysis – be concerned if onset greater than three * Possible loss of taste over anterior 2/3 of tongue, cannot control salivation on the affected side and inability to make tears * Somatic motor
Facial paralysis
Unable to: * Raise eyebrow and wrinkle brow * Close eye * Drooping of mouth * Blow out cheeks * Whistle

Possible ear pain and hyperacusis

SIGNS

* Unable to raise affected eyebrow and wrinkle brow. * Paralysis on the upper eyelid with loss of the corneal reflex on the affected side. * Difficulty closing eye * If the patient is asked to close their eye and show their teeth the eye ball rotates upwards and outwards: Bell’s Phenomenon * Decreased tear production * Mouth sag on affected side * Unable to blow out cheeks * Unable to whistle * Hyperacusis if the lesion of the facial nerve extends above the point where the branch of the stapedius muscle is given off.

DIAGNOSIS AND TREATMENT

* Blood test * CT scan * MRI

TREATMENT

• PO PREDNISOLONE 60mg od for 10 day then tapering course-aim to start within 72 hours.
• Eye protection if unable to fully close eye: anti-viral treatments

NURSING DIAGNOSIS

* Acute pain * Disturbed sensory perception * Disturbed body image

NURSING INTERVANTIONS

* Use artificial tears four times a day to lubricate the eye; wear an eye patch or tape the eye shut at night. Wear sunglasses when outside, when working on dusty conditions and when using any type of spray. * Apply moist heat to the affected side of the face, taking care not to burn the skin to reduce pain. * Massage the client’s face with a gentle upward motion two to three times daily for 5 to 10 minutes. * Arrange for privacy at mealtimes to reduce embarrassment * A soft diet that does not require chewing and six small meals a day are helpful. Chew slowly on the unaffected side ad avoid hot foods. * Oral care: Clear the mouth and carefully inspect the area between the gums and cheek for food after each meal. * As function returns, practice wrinkling the forehead, closing the eyes, blowing air out of the puckered mouth, and whistling for 5 minutes three or four times a day.

PATHOPHYSIOLOGY

Traumatic injury
Presence of a tumor
Viral infection

Blockage of the 7th cranial nerve

Parasympathetic
Uncontrollable salivation
Decreased tear production

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